Purpose of Public Policy Advocacy
Getting Started in Advocacy
How the Legislative Process Works
Opportunities for Grassroots Impact
Relationships with Congressional Staff
Commonly Used Titles and Job Functions of Congressional Staff

Purpose of Public Policy Advocacy

CHRISTUS Health's commitment to advocate for systemic change, with a preference for the poor, requires us to be active at the state and national level where far-reaching health care policy decisions are made. Congress and state legislative bodies continually make decisions -some driven by policy but many driven by budgetary constraints - that impact health care coverage, financing and delivery in our communities. Senators and representatives may not know the impact of their decisions on the people our organization serves unless we tell them.

CHRISTUS Health's facilities are members of multiple national, and state health care associations that lobby on behalf of all of their members. But, these associations cannot do the job alone. Associations can effectively deliver messages related to the broad implications of pending legislation or regulations, but only we can effectively explain to senators and representatives the specific consequences of legislative actions on our organizations and our community. Our involvement, as a constituent and community leader, is essential to make a senator or representative care enough about an issue to listen to the arguments, pro or con, and take a position.

One voice can make a difference, especially when it is heard by the right person at the right time. Legislators want to know what their constituents think about an issue before they take a position. Legislators also appreciate being recognized and thanked by constituents when they have been helpful or supportive.

An important measure of successful advocacy is the development of relationships with senators and representatives and/or their staffs in which:

• You are known to the congressional office.
• You are viewed as a credible and reliable source of information on health care issues.
• Your input is sought and valued.
• Your calls get returned.

Building relationships takes time and effort, and is equally as important as any single legislative issue. The keys to effective advocacy are building relationships and communicating - the same skills you use every day.

This handbook provides groundwork for public policy advocacy programs in our organization using the basic advocacy tools of written communications, phone calls and face-to-face meetings to influence senators and representatives. This handbook also includes information on the congressional legislative process; the best times to influence the process; the roles of congressional staff; legislative terminology; use of editorial pages; building coalitions; guidelines for tax-exempt organizations' involvement in political activities; state and local advocacy; and an advocacy assessment checklist for organizations and individuals.

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Getting Started in Advocacy

Advocacy is most effective when done on a planned, proactive basis. Key participants should be identified and informed on the issues, and relationships with legislators already developed, before an urgent need for action occurs. Here are some basic steps to take to begin an advocacy program in your organization:

1. Discover Existing Relationships
Find out where relationships between your organization, members of Congress and state/local government officials already exist. Ask board members, senior managers, physicians, volunteers, etc., if they know any legislators on a personal basis, and if so, whether they would be willing to serve as a contact with that legislator on important health care issues. Several relationships with legislators may already exist in your organization: for example, the chief financial officer may be in the Rotary Club with a legislator; a board member may volunteer in a member of Congress' political campaign; a nurse manager may be a leader in the state political party; or a senator's mother may volunteer in your organization. The best way to find out about these relationships is simply to ask.

2. Find Interested Participants
Identify individuals in your organization who are willing to become public policy advocates and develop relationships with senators, representatives and local legislators. These people may not know the legislators personally, but they can write letters, make calls and participate in visits when political advocacy needs arise. Seek out interested participants through inquiries at staff meetings, articles in internal communications, posters in the cafeteria and other forums. Individuals who have personal relationships with legislators combined with those who are willing to communicate with legislators can be the starting point for building an advocacy team. This group may serve as a local advocacy network for your organization and as a component of the CHRISTUS Health advocacy process at the national level.

3. Participation in Advocacy Initiatives
CHRISTUS Advocacy & Public Policy relies upon regional leadership, entity presidents, and leadership to identify persons at all levels of the system as front line advocates. Typically, about 100 persons within the system take an active role in public policy advocacy: These persons are called upon to present policy facts to elected officials, arrange on-site visits and sometimes travel to Washington, D.C., or the state capitols.During certain sessions of the congress or state legislative sessions sometimes special groups of advocates are coalesced in order to present a more powerful and systematic message. This advocacy includes meetings, e-mails, letters, calls, and trips.

4. Contact Your Legislators
It is always important to make contact with senators and representatives and develop relationships with them before your organization needs to contact them on an advocacy issue. Respond to requests from your Advocacy & Public Policy Council and from national and state associations to contact members of Congress on important legislative priorities. Send letters, make phone calls and participate in meetings as appropriate to respond to advocacy alerts or requests. This handbook contains guidelines for effective communications with senators and representatives and their staff members, which is an ongoing step in maintaining a relationship.

5. Develop an Advocacy Profile
Evaluate your CHRISTUS Health entity's existing relationships with senators and representatives and develop methods for building and strengthening these relationships. Consider activities such as:

• Hosting a visit to your organization for a member of Congress and/or a congressional staff member
  
• Meeting with members of your congressional delegation in Washington, D.C.
  
• Participating in local town meetings held by members of Congress.
  
• Developing a relationship with the local office staff of your senators and representatives.

A basic tool for each CHRISTUS Health entity should be an "advocacy calendar" so that consistent actions are taken at the best times during a calendar year. Our efforts are to help make CHRISTUS Health professionals trusted and valued resources to elected office holders and bureaucrats at any level of government. A format to begin your advocacy planning month by month is seen in our draft advocacy calendar. These will vary state by state.

How the Legislative Process Works

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Opportunities for Grassroots Impact

There are several parts in the legislative process when grassroots advocacy, factually and consistently presented, can impact an outcome.

CHRISTUS Advocacy often serves as a message-screening agent for CHRISTUS Health. Multiple groups including the American Hospital Association, the Catholic Health Association, the Premier Health System, Inc., and the Association of American Medical Colleges, will notify members of key issues and ask that certain procedures be used to deliver those messages to our state or federal legislative members. However, there are often times when a more CHRISTUS-specific message needs delivery and the best mechanism is determined by CHRISTUS Advocacy.

Bill Introduction/Sponsorship

Legislators can be encouraged to introduce a bill to address a specific issue, or to co-sponsor a bill introduced by another senator or representative. Obtaining a large number of co-sponsors on a bill is one strategy for gaining attention and credibility for an issue.

Subcommittee

The most important time for constituent involvement is the subcommittee stage. Legislators usually are not yet committed to specific bills or legislative language. Often, multiple bills are introduced on the same topic and grassroots communications can influence which bills the subcommittee considers. Grassroots advocates can communicate Their positions on the issue and suggest to legislators and subcommittee staff specific provisions or language to include in the bill. Action by constituents of subcommittee members can be very effective at this point.

Committee

Grassroots advocacy at the committee stage is also very important. Communications may focus on supporting or opposing specific language developed by the subcommittee; encouraging legislators to sponsor amendments; and asking a committee member to vote for or against the bill. Again, action by constituents of committee members can be very effective.

Floor (Initial Vote)

Constituent communications with senators and representatives is important when a bill comes to a floor vote. Grassroots efforts at this stage focus on encouraging legislators to vote for or against the bill; to sponsor a floor amendment; or to vote for or against a floor amendment offered by another legislator.

Conference

Opportunities for grassroots impact are more limited at the conference stage. A conference committee works out the differences between similar bills passed by the House of Representatives and the Senate. However, grassroots communications - particularly from constituents of members of the conference committee (conferees) - may influence whether a House or Senate provision is accepted in the compromise bill (conference report).

Floor (Post-conference Vote)

After a conference committee has worked out the differences between House and Senate versions of a bill, floor passage of the conference report is normally routine and will not be impacted by further constituent communications.

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Relationships with Congressional Staff

Building good working relationships with congressional staff is as important as developing relationships with senators and representatives. Staff are generally more accessible and legislators rely heavily on information provided by their staffs in making decisions and taking positions on legislation. You are most likely to be connected with staff, rather than the legislator, when you call a congressional office. Staff may be substituted for legislators in face-to-face meetings.

Don't let the young age of congressional staff deter you from taking time for visits and for very thorough factual meetings on health issues. These young persons represent "the best and the brightest" and their level of interest and understanding of an issue can influence the elected official.

Take time to offer background on your area of interest, bring staff up to speed on a topic then make your key points. A one or two page fact sheet emphasizing your points should be developed and left with staff for later reference. (Health Policy Discussion - Exhibit 1)

Staff members' level of expertise on health care issues varies considerably depending on the legislator's committee assignments and the staff member's tenure. Senators and representatives who sit on the key committees responsible for health care will most likely have personal staff members who focus on health care. Staff of legislators without health committee assignments may have health care as only one of many issues for which they are responsible. Many staff members are young, intelligent and enthusiastic people who wilt appreciate your efforts to explain complex health care issues in easily understood terms - particularly if health care is not their primary issue.

Each senator and representative has a personal staff in Washington, D.C., and in his or her district or state. The majority of the staff is in Washington, D.C., where they focus on day-to-day legislative issues. Congressional home office staffs are supervised by a district office manager or director and usually include a few caseworkers. If you want to meet with your legislators while they are at home, the district office staff is likely to be involved in the scheduling.

While district office staff members are usually not experts on legislation, they should still be included in your grassroots advocacy strategy. They act as eyes and ears for legislators on public reaction to issues back home. Information you provide on the local impact of proposed legislation will probably be well received by district office staff and communicated to staff in Washington or the state capitol.

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Commonly Used Titles and Job Functions of Congressional Staff

Administrative Assistant (AA) or Chief of Staff
The AA reports directly to the senator or representative and usually is responsible for evaluating the political outcomes of various legislative proposals and constituent requests. The AA or chief of staff usually handles the overall office operations, including the assignment of work and supervision of key staff.

Caseworker
The caseworker is usually assigned to help with constituent requests by preparing replies for the legislator's signature. The caseworker's responsibilities may also include helping resolve problems constituents present in relation to federal agencies such as Social Security and Medicare issues, veteran's benefits, passports, etc. There are often several caseworkers in a congressional office.

Legislative Assistant (LA)
Most congressional offices have several legislative assistants with expertise in specific areas. For example, depending on the responsibilities and interests of the legislator, an office may include different LA’s for health issues, environmental matters, taxes, etc.

Legislative Correspondent (LC)
The legislative correspondent reads, logs and tallies letters and other written correspondence from constituents and usually drafts replies on the legislator's behalf.

Legislative Director (LD), Senior Legislative Assistant or Legislative Coordinator
The legislative director usually monitors the legislative schedule and makes recommendations regarding the pros and cons of particular issues.

Press Secretary or Communications Director
The press secretary's responsibility is to build and maintain open and effective lines of communication between the legislator, his/her constituency and the media. The press secretary is expected to know the benefits, demands and special requirements of both print and electronic media and how to effectively promote the legislator's views on specific issues.

Scheduler, Appointments Secretary or Personal Secretary
The scheduler is usually responsible for allocating the legislator's time among congressional responsibilities, staff requirements, and constituent requests. The scheduler may also be responsible for arranging travel, speaking dates, visits to the district, etc.

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